How Not to Get Sick in the Third World

The secret to this is to regard everything that can go into your mouth as an enemy and a saboteur. You must accept in advance that you will not eat very well. But if successful, what you eat will stay eaten.

Rule One is no water except bottled water!! No matter what anyone says, don’t believe it!! Even bottled water should be bought in the largest possible store and the seal checked carefully – tap water is sometimes sold in used bottles. If you buy water in a small shop get the kind with bubbles, if available, so you know it really is kosher.

No Water is not as easy a rule as it appears. You have to THINK ABOUT EVERYTHING YOU PUT IN YOUR MOUTH! Ice, of course, is water. That delicious fruit drink probably has water in it. Even fresh juice may have encountered water in the juicer or the pitcher or the glass. Bottled soda pop is OK, usually (although sometimes contaminated in washing of bottles for re-use) but wipe out the glass before drinking – it may have been washed in contaminated water. If wiping out the glass is impossible socially, don’t drink the drink. (It might help socially if you explain that it’s water rather than dirt that you’re afraid of.)

Similarly if you drink from a bottle, wipe it off before letting it touch your lips – there may be melted ice on it. The same for plates and silverware. I carry my own boy scout knife-fork-spoon-cup set and wash it myself in bottled water. Eternal vigilance! Brush your teeth with bottled water. Keep your mouth tightly closed in the shower, and dry it with a towel before opening it. Don’t rely on water-purifying tablets – they don’t always work for all contaminants and they make water taste horrible.

Even salads can get you. Were they washed? If so, they were washed in contaminated water; if not, they are full of home-made organic fertilizer. Don’t eat them. Likewise use caution with cooked vegetables, pasta, stews, anything made with water, unless you have good reason to trust the specific kitchen where it was prepared. How long were they cooked? You have to boil water for quite a while – 14 minutes, I think, or maybe 21 – to get all the bugs for sure. Have you personally watched that soup boil for 21 minutes? If not, don’t eat it. Ditto tea – everyone will tell you tea is safe, and usually it is, but usually isn’t good enough. Again, the secret is to think about every drop and morsel before you touch it. If everything is first assumed to be poison, and you have to be affirmatively satisfied it is safe before you eat it, you’ll be all right. When in doubt, don’t!

Stock up on safely-sealed bottled water. Have enough for long bus trips and hot afternoons. Don’t ever get down to your last bottle – dehydration is dangerous too. While on the subject of water I should say: DON’T bathe in the Ganges, or in any Indian river or even in the ocean at an Indian beach. The water is badly polluted. Whatever you may have heard about its purity and healing properties, a dip in the Ganges is a prescription for instant hepatitis.

So what can you eat? Not much. Accept it. Reverse the rules you follow in America. In the Third World, packaged and processed is better for you than organic and fresh. In India, when I didn’t have good reason to trust the hotel kitchen, I have lived on processed cheese in tinfoil (imported is best), olives, salami I bring with me, bread baked before my eyes (but packaged crackers and indeed most breads and cakes are fine), candy bars, and similar items. Things in cans may be deadly if canned locally – stay away from them if possible (imported canned food is OK, but respect the expiration date). Fruit is fine if you peel it yourself – inside is sterile. The same with peelable raw vegetables like carrots and radishes and cucumbers. Raw peas can be delicious and are kosher if you buy them in the pod and open them yourself. Bring a simple fruit-peeler with you and wash it in bottled water after every use. Fruit served already peeled may have been washed after peeling – don’t eat it. Dates and honey are always OK; they are immunized by their sugar content from harboring bacilli or amoebas. Bananas are widely available in tropical countries and sterile if the peel is unbroken – eat all you want.

Milk may be infected with tuberculosis or cut with water – avoid it. The same is true for milk-based drinks like lassi. You should also avoid alcohol, first because there may be water in the glass and second because your system is already under siege and it isn’t a good idea to give it a poison. But beer is OK in a clean glass or from a hand‑dried bottle and is often the only alternative to yet more sugary Third World orange pop. Ice cream is sometimes OK as it is made in large factories usually, but can be served in a wet dish or can have been made with local water or TB-infected milk – better not unless you get it in the original package.

For social reasons you may have to accept the assurances of your hosts and eat in restaurants or hotel dining rooms. If you can possibly get out of it, do so. Say you’re on a special diet for your health – it’s true. (If you tell your doctor what you plan to do s/he’ll say you’re doing the right thing – then you can claim doctor’s orders for all your precautions.) If you can’t avoid restaurants, roasted or baked chicken is one of the safest things because it isn’t cooked in water, you know it has been cooked a long time, and the chicken was probably clucking that very morning. Also relatively safe is food deep-fried in oil (although the oil may be a bit off, but that’s usually a reasonable chance to take). Fried eggs are OK too, as are eggs hard-boiled in the shell. Poached eggs are not OK. Wipe the plate. Skip the soup. Skip the vegetables. Skip the salad. Skip the dessert. Really. (The rolls are OK but the butter may have TB or have been stored on ice.

Hot food that has been allowed to cool is especially dangerous in hot climates. This is another reason for avoiding restaurants, although restaurants that specialize in foreign tourists, or those in snooty hotels, are usually (but not always) OK. Fish and especially shellfish can be contaminated by polluted water, and are notorious for transmitting cholera. Don’t eat fish or shellfish in India! I have seen the fish markets. Need I say not to eat anything bought on the street except bottled soda, bread and cakes, unpeeled fruit, candy and dates? Or some other dish that survives your stern analysis, like the eggs fried in a wok on the Calcutta streets, and served in a chapatti – but refuse the salad greens that go with it. In India pan is OK, although not very filling.

The best defense is to be compulsive about not eating anything unpackaged. Go to a large store and stock up on cheese, crackers, candy, sardines imported from Europe, and so on. You should bring a supply of imperishables with you to last until you can go shopping. Hard salamis are very helpful, as is processed cheese in individual foil-wraped packets. Live on this stash and on bottled water (or beer or pop), and make no exceptions except where you have reason to trust the kitchen. At night the air is loud with the groans of tourists who made just one exception – the cooling drink, the tidbit on the street, the bowl of soup (it may have been the bowl, not the soup, that did them in). Be fanatical. Accept feeling silly. Accept feeling hungry if you have to. Blame it on your doctor (or blame it on me). You can be quite vague as to just why you’re being so picky. And you’re not lying – your body’s unfamiliarity with the local bugs actually does restrict what you can safely eat. And don’t believe what anyone tells you!

Such a restricted diet may make you deficient in vitamins. Be sure to take vitamin supplements every day. You will be exposed to unfamiliar germs everywhere, not just in the water – extra vitamin C will help your immune system cope with them. Wash your hands carefully, and dry them just as carefully, before eating anything. Keep hydrated.

This may be overkill – indeed it almost certainly is. But it beats underkill. Good luck! And bring some Lomotil or Imodium anyway, just in case. A shot of gamma globulin to boost your immune system is a good precaution also. And it can’t hurt to recite the Kali-mantra a few times before eating: Om Kali Durga nemo nemaha!